Can physical assessment techniques aid diagnosis in people with chronic fatigue syndrome/myalgic encephalomyelitis? A diagnostic accuracy study

Abstract

ObjectiveTo assess five physical signs to see whether they can assist in the screening of patients with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and potentially lead to quicker treatment.MethodsThis was a diagnostic accuracy study with inter-rater agreement assessment. Participants recruited from two National Health Service hospitals, local CFS/ME support groups and the community were examined by three practitioners on the same day in a randomised order. Two allied health professionals (AHPs) performed independent examinations of physical signs including: postural/mechanical disturbances of the thoracic spine, breast varicosities, tender Perrin’s point, tender coeliac plexus and dampened cranial flow. A physician conducted a standard clinical neurological and rheumatological assessment while looking for patterns of illness behaviour. Each examination lasted approximately 20 min.ResultsNinety-four participants were assessed, 52 patients with CFS/ME and 42 non-CFS/ME controls, aged 18–60. Cohen’s kappa revealed that agreement between the AHPs was substantial for presence of the tender coeliac plexus (κ=0.65, p<0.001) and moderate for postural/mechanical disturbance of the thoracic spine (κ=0.57, p<0.001) and Perrin’s point (κ=0.56, p<0.001). A McNemar’s test found no statistically significant bias in the diagnosis by the experienced AHP relative to actual diagnosis (p=1.0) and a marginally non-significant bias by the newly trained AHP (p=0.052). There was, however, a significant bias in the diagnosis made by the physician relative to actual diagnosis (p<0.001), indicating poor diagnostic utility of the clinical neurological and rheumatological assessment.ConclusionsUsing the physical signs appears to improve the accuracy of identifying people with CFS/ME and shows agreement with current diagnostic techniques. However, the present study concludes that only two of these may be needed. Examining for physical signs is both quick and simple for the AHP and may be used as an efficient screening tool for CFS/ME. This is a small single-centre study, and therefore, further validation in other centres and larger populations is needed.

Into the looking glass: Post-viral syndrome post COVID-19

“…Post-mortem SARS research indicated the virus had crossed the blood brain barrier into the hypothalamus via the olfactory pathway [2]. The pathway of the virus seemed to follow that previously suggested in CFS/ME patients, involving disturbance of lymphatic drainage from the microglia in the brain [3].One of the main pathways of the lymphatic drainage of the brain is via the perivascular spaces along the olfactory nerves through the cribriform plate into the nasal mucosa [4]. If the pathogenesis of coronavirus affects a similar pathway, it could explain the anosmia observed in a proportion of COVID-19 patients.…”

“…This disturbance leads to a build-up of pro-inflammatory agents, especially post-infectious cytokines such as interferon gamma, and interleukin 7 [5], which have been hypothesized to affect the neurological control of the 'Glymphatic System' as observed in CFS/ME [3]. The build up of cytokines in the Central Nervous System (CNS) may lead to post viral symptoms due to pro-inflammatory cytokines passing through the blood brain barrier in circumventricular organs such as the hypothalamus, leading to autonomic dysfunction manifesting acutely as a high fever and in the longer term to dysregulation of the sleep/wake cycle, cognitive dysfunction and profound unremitting anergia, all characteristic of CFS/ME.…”

“…Marked tenderness was also felt in the coeliac plexus. These signs have utility in aiding the diagnosis of CFS/ME [3].…”

Prevalence and correlates of chronic fatigue syndrome and post-traumatic stress disorder after the outbreak of the COVID-19

“…However, studies on the coronavirus and the influenza virus epidemics have suggested that these agents can alter the immune response. Moreover, the pro-inflammatory cytokines such as interferon-gamma and interleukins are released following the viral infection, passing through the blood-brain barrier and affecting the central nervous system (CNS) organs such as the hypothalamus (Hives et al 2017 ). The autonomic alteration consequence of hypothalamus involvement may result in cognitive abnormality, sleep/wake cycle dysregulation, profound fatigue, and myalgia in the long term in favor of CSF/ME (Carruthers et al 2011 ).…”

COVID-19 and chronic fatigue syndrome: Is the worst yet to come?

“…It has been argued that ME/CFS can be treated using the Perrin technique, based on traditional osteopathic concepts, to restore a healthier neuro-lymphatic flow. The Perrin technique is a system of manual diagnosis and treatment that is based on the hypothesis that ME/CFS is a disorder of the lymphatic drainage of the CNS, which leads to five physical signs [39] . I further postulate that patients with post-COVID-19 fatigue syndrome may also benefit from CSF drainage in the same way as CFS patients do [26] , [27] , [28] .…”